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Background: There is no data on the motives or characteristics of physicians choosing fellowship training in Hospice and
Palliative Medicine (HPM).
Methods: An electronic survey of HPM fellows initiating training in July 2009.
Results: Seventy six physicians initiated the study with 62 (82% of responders) completing all questions. Fifty five percent were
age 30-40 and 61% were female. Sixty eight percent were non-Hispanic Caucasian, 24% were Asian, and none were African
American. Fifty five percent were internal medicine trained. Most (86%) asserted that the care of a dying, critically ill or
symptomatic person impacted their decision to enter the field of HPM. Sixty three percent did not feel prepared to manage
dying patients and 41% felt personal regret at the care they delivered. The major reasons for choosing the specialty were a
desire to contribute to relief of suffering (79%), enhance end-of-life care (73%) and improve communication (78%). Ninetyfive
percent received negative comments about their career choice. Fifty nine percent had no exposure to hospice or palliative
medicine in medical school whereas 61% had an exposure available during residency. Forty seven percent decided to enter
fellowship in the 3rd year of residency and 33% applied after practicing in their primary specialty for a median of ten years.
Accreditation, strength of education, and a hospital palliative medicine service were required by the majority for selection of a
Conclusions: Negative experiences with end of life care in residency, particularly in the ICU, continue to be a factor in selection
of HPM as a specialty.
Susan B LeGrand is a Medical Oncologist and Specialist in Palliative Medicine. She is in active practice of both fields. Her residency training was at the University of Texas, Houston and the University of Arizona Cancer Center. She has published numerous articles and spoke widely on palliative medicine topics.